Thoughts from an academic burn surgeon/ surgical educator

Apparently moving and travel and…well, life have all been a little hectic. Let’s get back on track with the February reading round up, if we may.

Opioids and our role as surgeons in the current “opioid crisis” is an ongoing hot topic. This study helps to establish an evidence based for duration of postoperative opioid prescriptions.

If you’ve worked with me clinically you know that I am a big advocate for our pharmacists having a high level of engagement in the care of our patients, particularly those who are critically ill. Not surprisingly, this new French study shows that having our pharmacy colleagues enforce quality bundles decreases LOS and drug costs. Friends, listen to your pharmacists. They are very smart people!

Sexual harassment is yet another hot topic; I wish that Academic Medicine had made this statement free to all readers, but I want to let people know it’s out there if they have access. We’ve all got to work together to get harassment and discrimination of ANY sort into the “historical interest only” category. Zero tolerance is a key piece in that.

Closely related to this Academic Medicine viewpoint are two things from HBR. First, their current Big Idea focuses on “Now what?” around the #metoo movement. HBR podcasts also have a new “Women at Work” series that so far is worth the time invested in listening.

My other reading right now is Shawn Achor’s new book Big Potential. If you are leading a team or aspire to lead a team, or simply want to succeed in life, I would call it “highly recommended.”

It’s prompted lots of additions on Twitter, in which friends and colleagues have added spins to the comments from their own experiences. Some of these additions have been perhaps more egregious than anything cited in the original blog post.

Reading these comments, as well as recently hearing stories from women in training about ongoing flagrant sexual harassment at a variety of institutions, has me in a place that falls somewhere between rage and disgust. Sure, there are some physical things that men can do and women can’t and vice versa, but the modern social professional contract accepts that there should be equity in opportunity and equity in pay, and that gender, race, and other defining characteristics should not be limits. Nor should these defining characteristics provide a basis for degrading commentary or debasing actions from those who are threatened with the changes occurring in the professional power structure.

Yet here we are in 2018 with exactly those things continuing to occur.

Before we go any further, I’ll state that I know that MANY very good people who stand up routinely for those who have less power, who believe in social justice as something we have to actively pursue every single day. You know who you are, and I see you and appreciate your efforts.

Yet here we are in 2018 with people in positions of power who continue to deny opportunities to those who threaten their comfort zones and their world order. After all, we can’t have too many women in charge, can we?

Here’s something for you that’s not exactly a secret:

Sexism and misogyny are not just a women’s issue. They’re an everybody issue.

Here’s another not-so-secret idea:

Racism is not just a minority issue. It’s an everybody issue.Yet here were are in 2018, in which many are uncomfortable with sexism and racism AND have a fear of disapproval if they try to change the narrative.

How do we change this?

For those in positions of power and leadership who “get it”- you have to make sexism and racism unacceptable. Zero tolerance. And you need to “help” those who are sexist and/ or racist and have power by removing their power. It’s hard, it’s scary, and they’ll be angry. Without action they won’t change because so far they haven’t had to do so. Call. Them. Out. Use your power for good.

For those who are not in positions of power and leadership, you can still make a difference once you choose that the outcome (dismantling unjust systems) is of value. What small things can you do?

Ask someone to repeat their comment. It’s easy enough to throw the, “I must have misunderstood you…can you please repeat that?” card in a non-confrontational way. If they repeat something that seems mind-boggling to you (“General surgery is not an appropriate field for women”), another non-confrontational response might be, “Help me understand why you think that because I know of many successful women in general surgery.” Oh, and feel free to report your discussion to someone who has power over them and who understands why this isn’t okay.

Step in if you see someone in an uncomfortable or awkward position. If you don’t want to look at the person causing the issue and say “This seems very uncomfortable” it’s easy enough to shift things by coming up with something you need to discuss privately RIGHT NOW with the person being victimized. If you can, get their whole story and share it with a powerful ally who has influence over the perpetrator.

Was there something you wish you had said in a situation? Remember it and use it later!

What other ideas do you have for how we can create a climate that is fully respectful of our differences, both in little ways and in big ways? Please share here, or @ me on Twitter (@AmaliaCochranMD). What have you seen done well? We must do this together.

Last week on Twitter a sort-of related discussion evolved into a discussion about how people keep their ideas, concepts, and projects organized. Everyone’s got their own system, of course. Here’s the issue: not everyone’s system works for everyone else.

Confession that I believe I’ve made before, both on the blog and on Twitter: I have failed pretty much every list-based organization system out there. Remember the Milk is great if you do to-do lists well. Same for Todoist. I failed Remember the Milk before it was even super-cool.

If you’re a bit like me and are frustrated that you can’t seem to get systems that work for everyone else to work, I have a helper for you. Carson Tate is a Very Smart Woman who identified productivity styles amongst people she coached, and she has a free on-line assessment. I took her assessment a couple of years ago and it was mostly helpful because it allowed me to stop wasting my time on organization systems that are more linear and structured; it turns out that I am a Visualizer, according to her descriptions. We won’t discuss those bits in there about “spontaneity and impulsiveness” and “hasn’t seen the surface of their desk in years.” What I do know is that identifying my visualizer tendencies, putting my projects on a Personal Kanban white board using color-coded Post-its for different domains, and keeping my somewhat notorious Case of Markers close by has been undeniably useful. I wouldn’t recommend it for everyone (especially not the “kill me now” section of the Kanban board!), but for me, it’s effective, and far moreso than any other system I’ve identified. And for day-to-day as a place to store almost any of my crazy ideas, either short or long term, I’ve become a huge fan of Bear– and I want to believe I’ve converted a few of my Apple-using friends to it as well. I mostly love that I can use it on my MacBook, my iPad, or my iPhone, and I keep both personal (list of things that need to be done in the new house prior to move-in) and work (notes for my upcoming talk at the Wyoming/ Montana/ Idaho ACS Chapter meeting) in it. I’m also in the process of a trial of Lifetick- stay tuned on that one. It may be a little too organized and linear for me, but time will tell.

I hope that those of you who have a successful organization system will share ideas, either here or on Twitter. Or if you’ve failed one or more systems, please share that too. I’m hopeful we can all learn a bit from each other to start our new year off.

I’ve experienced grace. And light. And wonder. And inspiration. And joy.

Some days it’s been a genuine struggle to find any of those things, but they’ve always been there in some measure, no matter how small it has seemed at the time.

I’ve dreamed big, even when sometimes that’s meant not having any idea about some of the details. Honestly, there’s been plenty of “I don’t know exactly what this is going to look like, but I know it’s going to happen.” Consistently leaping has resulted in a net appearing, and I attribute that to more than luck.

I’ve asked hard questions of myself and of people around me. I’ve listened to the answers to those questions, and when I’ve found them unjust I’ve made it clear that’s not acceptable to me. In other words, there’s been a lot of integrity and authenticity, even when it’s uncomfortable (usually moreso for the person who doesn’t like my lack of interest in tolerating BS than it is for me).

I’ve said yes to things I’m excited to do, particularly when it involves people I adore. I’ve said no when it’s strategic. Hint: I have never, ever regretted a no. Not once. I can’t say the same for a few times when I’ve said yes and ended up resentful. I suspect there’s some wisdom in there.

Don’t be fooled: parts of this year have been arguably the most challenging of my life. But the group of people I alluded to last year who have my back no matter what? Yep. They’re still here.

Each year I select a “word of the year”. For 2018, I’ve known for a while that it had something to with light, or shining, or glowing. Christmas Eve I finally got it right with a word that lets me shine as I help other to do the same.

illuminate– to light up, to shine, to throw light on. Or…to help clarify or explain, to elucidate, to give insight into, to demystify

I’ll be doing more of that this year, friends, and I hope you’ll join me to let your light shine as well.

There’s the obvious “everything’s a little chaotic as I get ready to sell the house” going on, but other than that…I’m enjoying my first Christmas off in more years than I can remember. It’s been a long time.

Rather than pontificating about the end of the year, what 2017 has or hasn’t been, I realized that what I really wanted to was to share wishes for you for Christmas, or 2018, or Monday, or whatever it is that you choose today.

I wish you good health and safety

I wish you justice

I wish you kindness, both given and received

I wish you the ability to feel the fear and do big things that you’re passionate about anyway

I wish you the opportunity to create something meaningful to you

I wish you time with people for whom you care deeply (and who reciprocate that care)

I wish you moments of magic and wonder

I wish you both happiness and joy

And, as I sometimes provide with posts like this, a musical interlude that seemed just right for the occasion.

A couple of weeks ago I was out for one of my routine dinner dates with Gia Lewis and Tom Varghese; dinners like these are something I highly recommend as a way to stay connected to your core values with people who share them. And, of course, we manage to resolve plenty of the world’s issues and discover that we’re all wickedly funny. I also walk away from these dinners learning at least one new thing.

Other than encouraging you to hang out with people you adore (because we ALL need more of that!), there really is a point to the story about our recent dinner. We got into a fairly intense discussion of surgical culture and the fact that moving the needle to be more inclusive and kinder is just plain hard. Sure, there are all of those things that we learned in kindergarten (credit to Mind Shift for this great infographic).

But somehow in the moment of being an adult and trying to get ahead, we lose sight of so many of those things. Or we’re taught that they aren’t actually cultural expectations where we are, and slowly we become less connected to the value of not hitting people (perhaps not physically, but you get the idea) or telling people we are sorry. Most importantly, we transition from the idea of feeling guilty (“I did a bad thing”) to feeling shame (“I am a bad thing”). As Gia astutely stated, in surgery we are cultivators of artisan shame: “We water it, we cultivate it, we sell it at the Farmer’s Market on Saturday morning.” (See, I told you we’re funny, even when we’re speaking painful truth.) And, of course, shame is highly correlated with maladaptive behaviors and burnout.

So what is a surgeon to do to help herself and her colleagues function in a less shame-full world? Besides warm cookies and cold milk, how can we help change things? Brené Brown has some ideas, of course, since she’s made a career of researching shame- and I’ve had a couple of interesting email exchanges with her about shame and surgical culture.

Brené on surgical checklists: “When they teach those folks how to suture, they also teach them how to stitch their sense of self-worth to being all-powerful, and all-powerful folks don’t need checklists.”

Yep. This is us. This is who we are. And watching her TED talk again left me with so very many questions if we’re going to do this and foster a place that supports creativity and innovation…

How do we help each other be less afraid to fail?

How do we help each other to conquer impostor syndrome?

How do we help each other be “enough”?

How do we apologize to each other, to our patients, to their families when things go wrong and we make those mistakes?

How do we help our female colleagues understand that we do NOT have to do it all?

How do we help our male colleagues understand that it’s okay to be weak, it’s okay to fall down?

How do we get rid of secrecy, silence, and judgment that allow shame to flourish?

How do we help each other to show up being our best- and imperfect- selves?

Perhaps the secret starts exactly where we were on that Friday night- hanging out with people we adore. I want to believe it’s a first step.

Yes, you notice…I left “reading” out of it. I’m going to share exactly one article today relevant to academic medicine; I believe it’s that important and I don’t want you to miss it as many of us consider issues of “talent acquisition and development” in our profession.

We don’t have many WWII Veterans left out there. I’m grateful for the story from this one, and what a treat to see him fly in the plane he jumped from on D-Day!

Many of y’all have heard me say I have no designs to run a marathon, and I persist in that stance. That said, this woman’s description of what motivates her to train for a marathon aligns almost-perfectly with my thoughts on running. #irunbecauseigetto

We run because we get to

If you’ve kept up for any length of time around here, you know I am a fan of Eric Barker and his “Barking up the wrong tree” blog. In mid-November he dropped some wisdom about the friends we need in our lives, and there’s no time better than the holidays to look at that list (and the list definitely relates to the picture above from yesterday’s run-these ladies and I have referred to one another as “hide a body” friends more than once!). Related, his book that came out this year is the best leadership book I’ve read in the last 3 years. Truly.

I try to throw some good listening in here every once in a while. Chris Stapleton has a new album out as of Friday, and it’s worth your time. I promise.

And because I do believe we can all use some levity, I think this may be the best story of 2017. Can we make #drunkpossum trend on Twitter?

After last weekend’s latest horrific mass shooting, this article about converting bystanders to responders seems more relevant than ever. If you want to learn how to Stop the Bleed, look for a class here.

I’m hopeful, dear readers, that we can have a bit more of a dialogue this week. I need to learn something, and I particularly need the wisdom of the men in the audience.

One of the undeniable joys of spending last week on the road at the American College of Surgeons Clinical Congress is the time I got to spend with surgeon-friends from many places and at varied career stages. Yes, there was learning and thinking and organizational work, but at the end of the day the connection is (as ever) what means the most to me as I reflect. I came home so thrilled to know more about the work that my friends are doing, and feeling supported in my own.

As one would expect if I’m spending time with varied surgeon friends, it also means that I got to spend time with some phenomenal surgeons/ scholars/ leaders who happen to be women. As one would expect, plenty of stories get shared. As a qualitative researcher, I’m always looking for themes in stories, and last week was no exception.

What I heard was quite a few amazing, talented, accomplished women with tales of leadership roles deferred or denied, with the standard rationale of, “It’s not your time” or “We need to give Brad* a chance.”

This is where I need the crowdsourcing help, because I only know the female experience of many of my colleagues and myself. I feel like in the last year I’ve heard more and more of this sort of deferral or denial. Is “It’s not your time” code for implicit or explicit bias that keeps women out of leadership roles they have legitimately earned? Or is this a reflection of generational shift, and is something that’s being used to keep men and women who might buck the status quo a bit out of roles that, again, they have legitimately earned?

If this is simply reflective of old institutions dying with a long exhale, we need to address it. We need the best leaders in the most crucial roles, and we don’t need to wait for that.

If this is truly a “new” form of gender bias, it’s even more imperative that we address it. Nothing will change unless we do, and, again, we don’t need to wait.

Help me learn, readers- is this gender or generation bias at play?

*”Brad” is simply the standard guy, and is usually the standard white guy who doesn’t upset the apple cart. My apologies to any Brads out there because I do, in fact, know that some of you are amazing people and leaders who do think beyond tradition.